Key Points

The proportion of ICU admissions has increased over time.

The proportion of palliative care encounters has also increased but has not offset the cost of ICU stays.

In a study reported in the Journal of Oncology Practice, Mrad et al found an increase in the proportion of patients with stage IV lung cancer admitted to the intensive care unit (ICU) during terminal hospitalization between 1998 and 2014. A large increase in palliative care contacts also occurred, although related cost reductions did not make up for increased ICU costs.

The analysis included 412,946 patients with a terminal hospitalization identified in the National Inpatient Sample database between 1998 and 2014.

Increased ICU Admissions

The proportions of patients with ICU admission increased from 13.3% to 27.9% over this time (P < .001). ICU stay was associated with a mean adjusted increase of $18,461 per hospital stay.

During this period, palliative care encounters during terminal hospitalization increased from 8.7% to 53.0% (P < .01) and were associated with decreased use of aggressive care (eg, chemotherapy, invasive surgical procedures, radiotherapy, and ICU admission). Nevertheless, the decrease in total hospitalization costs associated with palliative encounters was modest, at $3,425 per hospitalization, and did not compensate for increasing hospitalization costs associated with ICU use. The overall inflation-adjusted mean hospitalization costs of terminal hospitalizations increased from $14,000 in 2001 to $19,500 in 2014.

Predictors of ICU Admission

On multivariate analysis, independent predictors of ICU care were age younger than 65 years, racial minority (compared with white), higher Charlson comorbidity index, Medicare or Medicaid insurance (compared with private insurance), teaching hospitals, and medium or large hospitals (compared with small hospitals).

The investigators concluded, “Among patients with metastatic lung cancer, there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health-care system.”

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